Search Results (636)

Background/Objectives: During pregnancy, the body undergoes numerous physiological changes, many of which are driven by significant hormonal shifts. Pregnancy rhinitis is a condition characterized by nasal congestion that occurs during pregnancy without any other signs of respiratory infection or known allergic causes. The aim of the study was to examine the impact of pregnancy rhinitis on the sense of smell. Specifically, it focused on determining how the nasal congestion associated with pregnancy rhinitis may alter olfactory perception in pregnant people. Methods: The study group comprised fifty women, aged 18 to 41, all in their third trimester of pregnancy. The control group was made up of 25 non-pregnant women between the ages of 25 and 31. Olfactory function was assessed using Sniffin’ Sticks, and each participant completed the SNOT-22 questionnaire. Additionally, ENT examination, nasofiberoscopy, rhinomanometry were performed. Results: The comparison between the control and study groups in terms of detection, discrimination, and identification test scores revealed statistically significant differences. The study group demonstrated lower odor average test scores, indicating worse olfactory acuity and poorer identification abilities, with these effects being strong. In addition, the study group showed a lower discrimination test score compared to the study group, though this effect was weak. On the other hand, the control group showed a higher level of discrimination test score compared to the study group, though this effect was weak. However, the pregnant women did not perceive any subjective impairment in their sense of smell even though they had smell disturbances confirmed in the Sniffin Stick test. The SNOT-22 questionnaire results indicated that the study group reported subjectively worse nasal patency compared to the control group. Conclusions: This controlled study demonstrated that olfactory disturbances, confirmed by the Sniffin’ Sticks test, affected half of the pregnant participants, with reduced smell sensitivity observed in advanced pregnancy compared to non-pregnant controls. Notably, more than half of the women with objectively confirmed olfactory deficits did not report subjective complaints, highlighting the need for greater clinical awareness of sensory changes during pregnancy. Pregnancy-related swelling of the nasal mucosa leads to impaired upper airway airflow, contributing to a reduction in olfactory sensitivity. Full article

Obstructive sleep apnea (OSA) is a chronic disorder associated with serious health consequences, yet many cases remain undiagnosed due to limited access to standard diagnostic tools such as polysomnography. Recent advances in artificial intelligence (AI) have enabled the development of deep convolutional neural networks that analyze craniofacial radiographs, particularly lateral cephalograms, to detect anatomical risk factors for OSA. The goal of this approach is not to replace polysomnography but to identify individuals with a high suspicion of OSA at the primary care or dental level and to guide them toward timely and appropriate diagnostic evaluation. Current studies have demonstrated that AI can recognize patterns of oropharyngeal crowding and anatomical imbalance of the upper airway with high accuracy, often exceeding manual assessment. Furthermore, interpretability analyses suggest that AI focuses on clinically meaningful regions, including the tongue, mandible, and upper airway. Unexpected findings such as predictive signals from outside the airway also suggest AI may detect subtle features associated with age or obesity. Ultimately, integrating AI with cephalometric imaging may support early screening and referral for polysomnography, improving care pathways and reducing delays in OSA treatment. Full article

Both allergic rhinitis and chronic rhinosinusitis with or without nasal polyps have important factors in common with asthma. They are often present simultaneously, they have similar pathogenesis processes, and they have synergistic effects on the clinical manifestations. There are also important considerations regarding the common treatment of these pathologies. Taking all these into account, it is possible to place these diseases under the “united airway disease” umbrella. However, matters such as embryologic origins, anatomy and function of the upper and lower airways, as well as cases where the aforementioned pathologies can be observed independently and have different treatment responses, make up reasonable counterarguments for the “united airway disease”. This narrative review attempts to put all these factors into perspective for a slightly better understanding of the complexity of this topic. We will take into consideration factors such as epidemiological data, pathogenesis and pathology, clinical considerations, and the benefits of a common treatment. Full article

(1) Background: The Iowa Oral Performance Instrument (IOPI) is the well-established device for assessing tongue strength. The current study aimed to assess the effectiveness of the HEAL device in patients with obstructive sleep apnea (OSA) exhibiting varying degrees of tongue base obstruction, as determined by drug-induced sleep endoscopy (DISE). All participants had undergone modified uvulopalatopharyngoplasty (UPPP), and tongue strength was measured using the IOPI. (2) Methods: This retrospective observational study utilized DISE to assess patterns of upper airway collapse in patients with OSA who were candidates for surgical intervention. Based on DISE findings, patients were divided into two groups: the M group (no or partial tongue base obstruction) and the S group (severe obstruction). The first tongue strength assessment using the IOPI was conducted one month after modified UPPP, prior to initiating HEAL training. Patients then underwent tongue muscle training with the HEAL device, starting one-month post-surgery. A second IOPI assessment was performed after at least one month of training. (3) Results: Forty-nine OSA patients with varying degrees of tongue base obstruction (assessed via DISE) received modified UPPP and were included in the analysis. The mean age was 38.3 ± 7.4 years, and mean BMI was 27.8 ± 3.9 kg/m². After training with the HEAL, average tongue strength increased by 20.6 ± 11.5 kPa. The M group showed significantly greater improvement than the S group (22.45 ± 11.77 vs. 13.33 ± 6.93 kPa, p = 0.024). Linear regression confirmed this difference remained significant (p = 0.024). (4) Conclusions: In this study, participants who received modified UPPP exhibited improvements in tongue base strength following a minimum of one month of training with the HEAL device. Those with no or mild tongue base obstruction, as determined by DISE prior to surgery, experienced greater improvements in tongue strength compared to those with severe tongue base obstruction. Full article

Robin sequence (RS) is a rare congenital anomaly characterized by micrognathia, glossoptosis, and upper airway obstruction (UAO), often accompanied by a cleft palate. The Tübingen Palatal Plate (TPP), also referred to as the pre-epiglottic baton plate (PEBP), offers a non-surgical, functional orthodontic solution that improves airway patency and feeding by advancing the tongue base. This paper outlines the semi-digital clinical and technical workflow used for TPP treatment at Tübingen University Hospital. The protocol combines intraoral scanning (IOS), computer-aided design and manufacturing (CAD/CAM), and manual refinement for patient-specific appliance production. Practical steps, modifications for special cases and follow-up procedures are detailed, aiming to support clinical implementation at other centres. Based on the published literature and over three decades of experience, the protocol emphasizes safety, quality control, and interdisciplinary collaboration, with practical guidance provided to support implementation in other centres. The potential of digital workflows for data sharing, training, and multicenter collaboration is highlighted, while challenges such as the need for specialized expertise and technical resources are acknowledged. This guideline provides the first comprehensive and reproducible description of the Tübingen approach and aims to facilitate wider adoption of TPP therapy for infants with RS. Full article

Background: Patients with congenital heart disease can associate malformations. The most frequent complications are those related to the airways, which produce prolonged cardiovascular postoperative. Objectives: Describe pathology, bronchoscopy indications, and findings in patients with heart pathology and persistent breath failure to improve prognosis and determine an early treatment. Methods: Retrospective descriptive study of bronchoscopies performed during 24 years in pediatric patients with congenital heart disease with surgery indication and persistent respiratory symptomatology. Results: We performed 199 fibrobronchoscopies in 144 patients, with an average of 1.4 fibrobronchoscopies per patient. A total of 58% were male. The mean age was 27.5 months (5 days–13 years). Valvular disease was the most frequent congenital heart disease, followed by the transposition of large vessels. The most frequent indications were stridor (42.7%) and persistent atelectasis (24.6%), followed by extubation failure (12.4%) and pump output (6.2%). The majority of the findings were found in the upper airway (56%), with a clear predominance of malacias (32%), while in the lower airway, extrinsic compression was highlighted (42%). Conclusions: Flexible fiberoptic bronchoscopy is a useful and rapid method for the diagnosis of airway malformations associated with congenital heart diseases that may have a relevant role in its management and prognosis. Full article

Objectives: Rapid maxillary expansion (RME) is widely used in orthodontics to correct transverse maxillary deficiencies. Beyond its skeletal and dental effects, RME may influence upper airway dimensions and respiratory function, particularly in growing individuals. This study aimed to evaluate the impact of RME on pulmonary function in adolescents using spirometric measurements. Materials and Methods: Fifteen adolescent patients (8 females, 7 males; mean age: 13.93 ± 2.89 years) diagnosed with maxillary transverse constriction underwent orthodontic treatment with acrylic-bonded RME appliances over a mean duration of 3.56 ± 0.67 months. Respiratory function was assessed via spirometry at baseline (T0) and one day after appliance removal (T1). Parameters recorded included peripheral oxygen saturation (SpO₂), forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), FEV₁/FVC ratio, and vital capacity (VC). Data were analyzed using the paired-samples t-test (for normally distributed variables) or the Wilcoxon signed-rank test (for non-normal distributions), with statistical significance set at p < 0.05. Results: Following RME treatment, all respiratory parameters showed a consistent upward trend but did not reach statistical significance. SpO₂ increased from 96.98 ± 0.96% to 97.01 ± 0.98% (p = 0.925). VC rose from 2.86 ± 1.07 L to 3.03 ± 0.80 L (p = 0.626). The FEV₁/FVC ratio improved from 90.88 ± 12.17% to 92.34 ± 7.37% (p = 0.742). Mean FEV₁ increased from 2.61 ± 0.72 L to 2.72 ± 0.68 L (p = 0.518), while FVC rose from 2.87 ± 0.75 L to 2.96 ± 0.69 L (p = 0.547). No adverse effects were reported during the treatment period. Conclusions: This study identified a non-significant but consistent trend toward improved pulmonary function following RME in adolescents. These preliminary findings should be considered hypothesis-generating rather than confirmatory evidence, as none of the outcomes reached statistical significance. While the observed upward trends in oxygen saturation, lung volumes, and expiratory performance suggest potential respiratory benefits, larger-scale, controlled, and long-term studies incorporating both spirometric and anatomical airway assessments are needed to validate these observations. Full article

Background: Obstructive sleep apnea syndrome (OSAS) and impaired nasal breathing are common in children and are frequently linked to maxillary constriction. Rapid maxillary expansion (RME) is an orthopedic treatment used to increase upper airway dimensions and improve respiratory function. It has been hypothesized that RME could contribute to improvements in behavior and cognition, possibly through enhanced sleep and respiratory function. It also promotes the shift from oral to nasal breathing, supporting craniofacial development and neuromuscular stability, and it is increasingly recognized as a multidisciplinary intervention that can improve pediatric health outcomes. With increasing evidence supporting its efficacy, RME should be considered not only for its orthodontic benefits but also as a multidisciplinary treatment option within pediatric care protocols. This underscores the importance of integrated care among orthodontists, ENT specialists, and pediatricians. Aim: To systematically assess the impact of RME on nasal respiratory parameters and sleep-disordered breathing, particularly OSAS, in pediatric patients. Methods: Following PRISMA guidelines, a systematic review was conducted using 12 clinical studies evaluating anatomical and functional respiratory changes after RME in children with mouth breathing or OSAS. Parameters included airway volume (CBCT, cephalometry), nasal resistance (rhinomanometry), and polysomnography (PSG) data. Results: RME consistently resulted in significant increases in nasal cavity volume and upper airway dimensions. Multiple studies reported reductions in the apnea–hypopnea index (AHI), improved oxygen saturation, and better subjective sleep quality. Longitudinal studies confirmed the stability of these benefits. However, variability in study protocols limited meta-analytical comparison. Conclusions: RME is effective in enhancing nasal breathing and mitigating OSAS symptoms in children. While results are promising, further high-quality randomized controlled trials are needed to validate these findings and guide standardized treatment protocols. Full article

Background: The aim of this article is to describe the protocol of a large, multicenter randomized controlled trial evaluating the effects of orofacial myofunctional therapy with auto-monitoring (OMTa) versus auto-monitoring alone on obstructive sleep apnea (OSA) assessed by the apnea–hypopnea index and other pre-specified outcomes. Method: The OMTaOSA study protocol was registered at ClinicalTrials.gov (NCT06079073) in August 2023, and data collection ended in January 2025. One hundred and four participants with mild and moderate OSA were included. Randomization was conducted in a 1:1 ratio, using sex-stratified blocks. The intervention was a standardized protocol of OMT exercises previously shown to be effective, auto-monitoring with a Withings scan watch, and feedback from self-reports. Controls received watches and access to the same application without the exercise module. Sleep was measured over three nights at baseline and after three months. The sleep scorer and researchers evaluating other outcomes were blinded to the treatment allocation. Change in the apnea–hypopnea index was defined as the primary outcome. Secondary outcomes are published on Clinicaltrials.gov. Results: The results of the trial are still in preparation. Conclusions: By addressing the limitations of previous OMT studies, this trial may clarify the effectiveness of digitally delivered OMT for patients with mild to moderate OSA. Full article

Background/Objectives: The maxillary labial frenum (MLF) is a connective tissue structure attaching the upper lip to the maxillary alveolar process. Its morphology varies significantly among individuals and is often most prominent during early childhood. While hypertrophic or low-attaching frena have been associated with diastemas, feeding issues, and speech impairments, there is no causal evidence supporting early surgical intervention. This review aims to examine current evidence regarding the timing and necessity of frenectomy procedures and to evaluate the implications of early versus delayed intervention. Methods: A narrative review was conducted using twenty peer-reviewed articles published in the past 10 years, with one additional article from 2012 included for its ongoing relevance. Databases searched included PubMed, the NIH database, the Reference Manual of Pediatric Dentistry, and journals from the American Academy of Pediatrics. Inclusion criteria were English-language, peer-reviewed studies that addressed the morphology, classification, diagnosis, management, and outcomes of MLFs across age groups. Excluded were studies focusing solely on mandibular, buccal, or lingual frena; non-English publications; case reports; and articles lacking full-text availability. Results: The literature suggests that premature frenectomy, prior to the eruption of permanent maxillary canines, typically between 9 and 12 years of age, is associated with frenum regrowth, surgical complications, and orthodontic relapse. Additionally, a lack of standardized diagnostic criteria contributes to inconsistent clinical decision-making. Conservative management, including monitoring, is strongly recommended as the frenum often migrates apically as the maxilla develops. Factors such as airway obstruction and developmental delays should be ruled out before considering surgery. Conclusions: There is insufficient evidence to support early surgical intervention for MLF-related concerns. A conservative, individualized approach, delaying frenectomy until after permanent canine eruption, may minimize complications, improve long-term outcomes, and allow the frenum to migrate apically as the patient develops. Standardized diagnostic tools are urgently needed to guide clinical decision-making. Full article

Background and Objectives: Flexible bronchoscopy is widely used for evaluating intrathoracic airway and pulmonary diseases. However, its diagnostic value in upper airway abnormalities, including those involving the larynx, pharynx, and proximal trachea, remains underexplored. We evaluated the diagnostic significance and effectiveness of bronchoscopy in assessing upper airway diseases, including those involving the larynx, based on real-world data. Materials and Methods: We conducted a retrospective observational study involving 2229 patients who underwent bronchoscopy between March 2019 and December 2023. Patients with abnormal upper airway findings during bronchoscopy were referred for further otolaryngological evaluation. Patients were categorized according to the experience of their bronchoscopist (with ≥100 procedures defining experienced). Abnormal findings were analyzed according to anatomical region (oral cavity, larynx, and vocal cords), disease status (benign vs. malignant), and patient demographics. Multivariate logistic regression was used to identify predictors of abnormal findings. Results: Among 2229 patients (mean age 65.4 years), 72 (3.2%) exhibited visible upper airway abnormalities. No significant differences were observed in the abnormality detection rates between experienced and inexperienced operators across all anatomical regions. However, the presence of malignant disease was significantly associated with a higher likelihood of detecting abnormalities (5.4% vs. 1.9%, p < 0.001). Multivariate analysis revealed that male sex (odds ratio [OR] 2.069, p = 0.017), age < 74 years (OR 2.404, p = 0.009), and malignancy (OR 3.030, p < 0.001) were independent predictors of abnormal findings. Conclusions: Flexible bronchoscopy can incidentally detect upper airway abnormalities, particularly in patients with malignancy, male sex, or younger age. These findings suggest that systematic inspection of the upper airway during bronchoscopy may offer additional diagnostic value, regardless of the operator’s experience. The integration of upper airway assessment into routine bronchoscopic practice may enhance the early detection of clinically significant lesions and improve comprehensive patient care. Full article

Obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by partial or complete blockage of the upper airway during sleep, leading to disrupted airflow and fragmented sleep. Maxillary expansion has emerged as a promising treatment option, as widening the maxilla can increase nasal airway volume and improve airflow. The treatment options for maxillary expansion include rapid maxillary expansion (RME) for pediatric patients, mini-screw-assisted rapid palatal expansion  (MARPE) for adolescents and adults, surgically assisted rapid palatal expansion (SARPE) for skeletally mature individuals, and distraction osteogenesis maxillary expansion (DOME) for adults with severe maxillary constriction and nasal obstruction.  This comprehensive review explores the role of maxillary expansion in the management of OSA, examining its clinical applications and potential effectiveness as a therapeutic intervention. Full article

Introduction: Maxillary setback in orthognathic surgery has been extensively discussed regarding its effects on bone healing and facial soft tissue profile; however, its impact on upper airway volume remains unclear. Objective: We evaluate the influence of maxillary setback combined with counterclockwise (CCW) rotation of the occlusal plane on upper airway dimensions. Methods: A retrospective observational case series was conducted with eight patients diagnosed with Class II malocclusion who underwent orthognathic surgery involving maxillary setback and CCW mandibular rotation. All procedures were performed by the same surgeon. Preoperative (T1) and 6-month postoperative (T2) facial CT scans were analyzed using Dolphin Imaging software11.7 to measure airway volume (VOL), surface area (SA), and linear distances D1, D2 and D3. Statistical analysis was performed using the Wilcoxon test with a 5% significance level. Results: Significant skeletal changes were observed, including 10.2 mm of mandibular advancement, 5.2 mm of hyoid advancement, and 4.1° of CCW rotation. Although increases in airway volume and surface area were noted, they did not reach statistical significance (p = 0.327 and p = 0.050, respectively), but suggesting a favorable trend toward airway adaptation. Conclusions: Maxillary setback combined with CCW rotation appears to safely correct Class II skeletal deformities without compromising upper airway space. These preliminary findings highlight the technique’s potential for both functional and aesthetic outcomes, warranting further long-term studies. Full article

Objective: The prevalence and severity of obstructive sleep apnea (OSA) increase with age, suggesting that age-related factors are etiological factors for OSA in older adults. In addition to anatomic contractions of the upper respiratory tract, such as those caused by obesity and retrognathia, sleep is impaired in older OSA patients due to aging. Although aging has long been associated with structural changes in the upper airway potential, specific age-related anatomical differences in patients with OSA are not established. This study aimed to examine age-related morphological differences in OSA patients, particularly in older adults. Methods: This study was designed as a retrospective cross-sectional study conducted at the Center for Dental Sleep Medicine, Osaka Dental University, between May 2017 and September 2022. From an initial cohort of 1032 patients, 183 male participants were included after applying strict inclusion and exclusion criteria. Patients were classified into two age groups: middle age (40–60 years) and older age (≥65 years). Polysomnographic parameters; body mass index (BMI); airway space (AS) obtained from cephalometric radiographs; length of the soft palate (PNS-P); SNB angle, as an indicator of mandibular position; and the position of the hyoid bone (MP-H) were compared between the groups. Statistical analysis included Levene’s test for homogeneity of variances, independent sample t-tests for group comparisons, and multiple regression analyses to identify independent predictors of AHI. This study was conducted with the approval of the Ethics Committee of Osaka Dental University (No. 111047). Results: Older patients showed significantly lower REM sleep percentage (13.5 ± 1.31% vs. 16.4 ± 0.59%, p = 0.047), significantly lower BMI (23.6 ± 0.45 kg/m² vs. 24.6 ± 0.29 kg/m², p = 0.049), and significantly larger AS (15.8 ± 0.52 mm vs. 12.0 ± 0.27 mm, p = 0.000) compared to middle-aged patients. Furthermore, in the middle-aged group, BMI (β = 0.40, 95% CI: 1.46 to 3.41, p < 0.001), SNB (β = −0.18, 95% CI: −1.75 to −0.09, p = 0.030), and MP-H (β = 0.19, 95% CI: 0.10 to 1.01, p = 0.018) were significant independent predictors of AHI. In the older group, no parameters were significant predictors of AHI. Conclusions: We found that older adult patients had a larger airway diameter and lower REM sleep percentage and BMI than middle-aged patients. Furthermore, regarding factors associated with AHI, which is an indicator of sleep apnea severity, in the middle-aged group, anatomical factors such as BMI, SNA, and MPH contributed significantly, but in the older adult group, anatomical factors were not relevant. The results suggested that anatomical factors alone may not fully explain the pathogenesis of OSA in older patients, highlighting the need for further studies focusing on other age-related factors. Full article

Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed condition that significantly increases perioperative morbidity and mortality in both adult and pediatric populations. Its pathophysiology, involving intermittent upper airway obstruction during sleep, poses unique challenges for anesthesiologists due to altered airway anatomy, increased sensitivity to sedatives, and unpredictable ventilatory responses. This comprehensive review summarizes current evidence on the anesthesiologic management of OSA patients, focusing on preoperative screening, risk stratification, intraoperative considerations, and postoperative care. Effective management of OSA requires a multidisciplinary and individualized approach. Preoperative assessment should include validated tools such as STOP-Bang or polysomnography when available. Intraoperative strategies include careful titration of sedatives and opioids, airway protection techniques, and use of short-acting agents. Pediatric patients present specific anatomical and physiological risks, particularly in adenotonsillectomy cases. Postoperative monitoring, especially in the first 24 h, is critical to detect respiratory depression, with CPAP therapy often beneficial in selected patients. Recognizing and appropriately managing OSA in surgical candidates is crucial for improving outcomes and reducing complications. Anesthesiologists should tailor perioperative strategies to the severity of OSA, age group, and type of surgery. Future research should aim to refine predictive tools and establish standardized protocols, particularly in pediatric populations. Full article